So embarrassed today and nervous (re vital signs)

peytonsmom · Sep 10, 2009

I second the poster that said to make sure the person's arm is really straight when you're looking for the brachial. I was beginning to think I was hopeless until I figured that out. Once I did, I was able to find it on just about everyone.

Don't feel bad either. You should have seen all of us in the skills lab last night w/ that "deer in the headlights" look going on.

It doesn't help that we have never gone over any of the VS's in class, have an ATI module to complete, and 2 peer evals due before the checkoff and have a med term and math quiz all on the same weekend. *sigh*

mb1949 · Sep 11, 2009

I too am an older student, with no healthcare experience. I couldn't do the simplest things at first, BP and Apical pulse were my worst nightmares. Just keep practicing, believe me one day it will all fall in place, believe me one day I just woke up and could hear everything, so relax, take your time, and practice practice practice! By the way, a good stethoscope will be your best friend, I too have the Littman, best investment I ever made, I bought it on line it wasn't too expensive, Good luck to you!!!!!!

That Guy, BSN, RN, EMT-B · Sep 11, 2009

Ok one hint instead of counting seconds instead of pulses is dont look at your watch. Know what time you started and look back in a few seconds to see how far you are.

Thats all I got.

Fundamentals(1986) · Sep 11, 2009

This is a late response but I hope you passed your vital signs check-off. Im right behind you, I take my vital signs check off on Tuesday! I know I'm still new and all but I think I'm pretty good at finding brachials, or I'd like to think so, just apply more pressure until you find it, the landmark is usually at the inner side of the elbow. I only have trouble remembering all the little details such as providing privacy, lowering bed/bed rails, and asking for pain, because I get nervous and my mind becomes scrambled eggs

Ayvah, RN · Sep 11, 2009

Ditto to the above!

I'm repeating a lot of what was already posted, but here goes anyway

pulse - find it on yourself by putting one hand on the table, palm up. Take the first 3 fingers of your other hand, and put them on the middle of your wrist, and let them slide left or right to the side that your thumb is on. There is a small groove that should fit your fingers pretty well. Change the pressure of your three fingers until you can feel the pulse. The third finger should be right at the line where the hand begins, and you should feel the pulse at about the middle finger. If you are obtaining vital signs on a patient and you are having difficulty finding their pulse, you can always use your stethoscope to listen to the heart and get an apical pulse. I've done this before especially with patients who have weak pulses. Edema is a big reason why it can be hard to find pulses. (If you can't find a pulse on a patient you need to make sure you assess that their circulation isn't impaired by doing things like capillary refill checks/ checking skin temperature /dopplar)

Brachial pulse - put one arm on the table again, palm up. Use the other hand's three fingers again, put the middle one on the line in your skin where the arm bends. Use some pressure. If you don't feel the pulse, move your fingers slightly closer towards your body.

BP - have the person remove any jackets or sweaters they have on. Wrap the cuff so the arrow on the cuff is pointed towards the brachial artery. Check the bulb so that it is twisted closed but not twisted so hard that you'll have problems loosening it smoothly. Tap the panel of the steth that you are going to place on the skin so you can hear it and are assured it is working correctly. If you have previous BP readings on a patient, you can inflate the cuff to maybe 30 or so above that, before you start deflating it. If you immediately hear it in your steth, stop and inflate more. Deflate slow and you can always go faster if you need or slower. If you feel like you need another cue for when to expect the systolic, ask to take a preliminary blood pressure first. Find the pulse, inflate the cuff, and feel when the pulse stops/starts again. That is approximately your systolic. If you are still having problems hearing, try the other arm.

Respirations - After you have taken the pulse, keep your hand on the person's wrist, and look at any area of their body that moves with respirations. It may be their shoulders, it may be their clothing towards the belly that moves. Or like another person said, have the patient's wrist on their belly so you can feel the movement as they breathe.

And I must strongly disagree that you'll never touch a manual bp again. Automatic machines often times give inaccurate readings! Many times when the tech would report to me a blood pressure that's too high or too low, I'd go in there and do a manual one, and have a fine BP. This should be the first thing you do, by the way, if you get a bad reading from an automatic machine. I do manual BPs almost daily.

So, practice on yourself over and over till you are completely comfortable finding your own pulses, then go get 'em!

Kringe38 · Sep 11, 2009

I'm getting better with the pulses and actually did that part of the check-off okay but did not pass the BP check-off. I'm so mad and sad at the same time. Someone will go over it with me one-on-one before I have to try again. So scared that I will not make it and get thrown out over taking BP.

Another thing also annoys me. We were split up into partners to do the check-offs. The classmate who was taking my BP couldn't hear the top number and then she told the instructor that other classmates who've taken my BP in practice haven't been able to hear my top number, either. So she got to re-try on someone else. I sort of feel like if I can't hear someone else's top number, it's my fault, and if someone can't hear my top number, it's also my fault! She also forgot to release the cuff all the way after hearing my bottom number on the second try.

I wasn't sure what top number I was hearing - the instructor was hearing it lower than I was - and I was getting too low of a bottom number also. I thought I had the bottom number down. So now I don't know what the H is going on.

ETA: Out of curiosity, anybody know if there some reason, some physiologic reason unique to me, that people wouldn't be able to hear my top number?

bluemushroom · Sep 11, 2009

Don't be mad about not passing the BP part of your check-off. It's ok. It takes some people more than one try to pass a check-off. You'll pass, and you won't be thrown out of nursing school. :icon_hug:

Good luck on your next try!

I did my vital signs check-off on Tuesday, and I was so nervous. When I practiced at home, I didn't have a problem with doing any of it, but I got really nervous when I had to do the check-off. I was shaking so much that I couldn't feel a radial pulse, and I lost count when I finally did feel it. I also messed up doing BP. My instructor told me it was ok and to try again. I calmed down a little, tried again, and I passed.

brokenroads27 · Sep 11, 2009

i've been there! last year when we had a vital signs test off i failed....i got way too nervous and wasn't confident with what i was doing. thats what i comes down to-feeling confident and KNOWING that you are doing it correctly. keep practicing. if your lab instructor is anything like mine he/she will help you until you get it RIGHT. it just takes time. how much have you practiced? and who are you practicing on? for the brachial pulse, you have to press pretty firmly to feel it, expecially in someone overweight. keep your head up and you'll do fine!

Kringe38 · Sep 11, 2009

I've practiced on my parents and on some of the other students. I never feel confident. I was hoping practicing at home with my own cuff would make me more confident but it has not.

MattiesMama · Sep 12, 2009

I'm getting better with the pulses and actually did that part of the check-off okay but did not pass the BP check-off. I'm so mad and sad at the same time. Someone will go over it with me one-on-one before I have to try again. So scared that I will not make it and get thrown out over taking BP.
Another thing also annoys me. We were split up into partners to do the check-offs. The classmate who was taking my BP couldn't hear the top number and then she told the instructor that other classmates who've taken my BP in practice haven't been able to hear my top number, either. So she got to re-try on someone else. I sort of feel like if I can't hear someone else's top number, it's my fault, and if someone can't hear my top number, it's also my fault! She also forgot to release the cuff all the way after hearing my bottom number on the second try.
I wasn't sure what top number I was hearing - the instructor was hearing it lower than I was - and I was getting too low of a bottom number also. I thought I had the bottom number down. So now I don't know what the H is going on.
ETA: Out of curiosity, anybody know if there some reason, some physiologic reason unique to me, that people wouldn't be able to hear my top number?

The most common mistakes for B/P is counting the top number too high and the bottom number too low...people usually get the top too high because they start counting when the nanometer starts ticking not when they actually HEAR the sounds, and the same "rule" applies to the diastolic...you are unsure, you still see it ticking a little, so you overestimate it.

When you practice, try closing your eyes and just listening...don't worry about reading the numbers, just get used to what it sounds like.

After you feel comfortable in knowing what you are listening for, try it again only this time don't look at the nanometer until you hear that first sound, and THEN check the number -that's the systolic. Then look away again (you don't need to make it obvious, just divert your eyes) and when the sounds stop check again-that is your diastolic.

As far as not being able to "hear your top number"-the only 2 physiological reasons I can think of (well there are 3 but I'm assuming you are not an infant ) are if you are in hypovolemic shock or extremely obese. More likely, you could just be slightly hypovolemic, hypotensive or a little overweight which can make reading difficult...regardless it is not YOUR fault and your classmates should not be able to use that as a "cop-out" for not being able to get a reading on you!

Kringe38 · Sep 12, 2009

The most common mistakes for B/P is counting the top number too high and the bottom number too low...people usually get the top too high because they start counting when the nanometer starts ticking not when they actually HEAR the sounds, and the same "rule" applies to the diastolic...you are unsure, you still see it ticking a little, so you overestimate it.
When you practice, try closing your eyes and just listening...don't worry about reading the numbers, just get used to what it sounds like.
After you feel comfortable in knowing what you are listening for, try it again only this time don't look at the nanometer until you hear that first sound, and THEN check the number -that's the systolic. Then look away again (you don't need to make it obvious, just divert your eyes) and when the sounds stop check again-that is your diastolic.
As far as not being able to "hear your top number"-the only 2 physiological reasons I can think of (well there are 3 but I'm assuming you are not an infant ) are if you are in hypovolemic shock or extremely obese. More likely, you could just be slightly hypovolemic, hypotensive or a little overweight which can make reading difficult...regardless it is not YOUR fault and your classmates should not be able to use that as a "cop-out" for not being able to get a reading on you!

I am going to get hold of some "victims" today and practice what you said. I am pretty obese so maybe this is why, but the instructor acted like she did hear my top number at least once but went ahead and gave her another chance with someone else when she claimed no one could hear my top number. I guess I just have to focus on what I need to do but can't help feeling a little ticked. :banghead: I don't think I should have been hypovolemic that day. I tend to run toward hypertension and I was totally freaked out so my pulse should have been pounding - I kind of thought that would make my numbers stand out, though I'm certainly no expert and have no idea if this is true.

MattiesMama · Sep 12, 2009

It probobly is the extra weight then...you have more subcutaneous tissue over your artery so that will tend to muffle the noise. My stepmom had gastric bypass done but she told me when she was heavy the nurses always had a really hard time getting her B/P. Do you have an extra-large cuff? If not I would suggest getting one, cuff size can make a big difference.

The fact that your B/P is hard to read might actually work to your advantage in the end, because if you can read it on yourself, you should have no problem with a "normal" patient. My B/P isn't hard to read but it is all over the place because my medications, so I have like 4 patients in my own body that I can practice on